Laparoscopic Versus Open Repair of Inguinal Hernia

Abstract

SummaryBackground and objective. Inguinal hernia repair is one of the most common general surgery procedures. Laparoscopic repair is technically more demanding, though it has been shown to be superior in terms of pain and discomfort, however, there is no apparent difference in recurrence between laparoscopic and open mesh methods of hernia repair. Over the years we see a relatively slow increase of laparoscopic procedures and even scepticism of the patients; thus we decided to test the hypothesis that more demanding and costly laparoscopic surgery has little benefits over the open procedure. The aim of our study was to compare postoperative pain, short-and long-term outcomes after laparoscopic hernia repair and conventional open hernia repair. Results. Laparoscopic procedure was significantly more often performed for the patients, who were younger, had shorter history of disease. The mean operative time for laparoscopic inguinal hernia repair was significantly longer than for open repair (p=0.02). The pain score for laparoscopic surgery was significantly lower according to VAS on day 1, 2, 3 (overall p≤ 0.002). The patients in the laparoscopic group required significantly lower doses of narcotic analgesics on the third postoperative day; the doses of nonsteroidal anti-inflammatory drugs were also significantly lower on the second and third postoperative day in this group. The postoperative hospital stay was shorter after laparoscopic repair (p=0.01). Sixty-four patients (71.11%) completed follow-up at one year after the operation. Nine (14.06%) of them had postoperative complications and eight of them were after open hernia repair. Two patients (3.1%) were re-operated (both patients were treated by Lichtenstein hernioplasty): one for inguinal hernia recurrence, another for testicular necrosis. Conclusions. The patients from laparoscopic group had significantly shorter postoperative pain duration (p=0.019), returned to daily activity slightly earlier and had better satisfaction with the operation comparing with the patients who undergone open surgery (p=0.915, p=0.893), but the duration of the sick leave (time off from work) was similar in both hernia repair group (p=0.260). Data shows that laparoscopic hernia repair has advantages in terms of post-operative pain intensity and duration, as well as risk of complications and patient satisfaction.

Comparison of Outcomes of Open Tension-free Mesh Repair and Totally Extraperitoneal Laparoscopic Repair of Inguinoscrotal Hernias

“…Our finding on operative time was that the laparoscopic approach took longer, but the difference between the mean values of the two groups was not statistically significant. This finding is in line with what is found in literature, as laparoscopic approach is technically more challenging, associated with a longer learning curve and requires general anesthesia (6).…”

“…and in all patients with primary bilateral inguinal hernia. When a recurrence occurs and the previous repair had been laparoscopic, the operation of choice should be open repair; if the previous repair was open, the operation of choice should be laparoscopic repair (6)(7)(8)(9). The recurrence rate for Lichtenstein repair in our study was 2.9% and for TEP repair 14%.…”